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Rodrigo E, Quintana LF, Vázquez-Sánchez T, Sánchez-Fructuoso A, Buxeda A, Gavela E, Cazorla JM, Cabello S, Beneyto I, López-Oliva MO, Diekmann F, Gómez-Ortega JM, Calvo Romero N, Pérez-Sáez MJ, Sancho A, Mazuecos A, Espí-Reig J, Jiménez C, Hernández D. Tubulo-interstitial inflammation increases the risk of graft loss after the recurrence of IgA nephropathy. Clin Kidney J 2024; 17:sfad259. [PMID: 38186867 PMCID: PMC10768752 DOI: 10.1093/ckj/sfad259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Indexed: 01/09/2024] Open
Abstract
Background Immunoglobulin A nephropathy (IgAN) is the most frequent recurrent disease in kidney transplant recipients and its recurrence contributes to reducing graft survival. Several variables at the time of recurrence have been associated with a higher risk of graft loss. The presence of clinical or subclinical inflammation has been associated with a higher risk of kidney graft loss, but it is not precisely known how it influences the outcome of patients with recurrent IgAN. Methods We performed a multicentre retrospective study including kidney transplant recipients with biopsy-proven recurrence of IgAN in which Banff and Oxford classification scores were available. 'Tubulo-interstitial inflammation' (TII) was defined when 't' or 'i' were ≥2. The main endpoint was progression to chronic kidney disease (CKD) stage 5 or to death censored-graft loss (CKD5/DCGL). Results A total of 119 kidney transplant recipients with IgAN recurrence were included and 23 of them showed TII. Median follow-up was 102.9 months and 39 (32.8%) patients reached CKD5/DCGL. TII related to a higher risk of CKD5/DCGL (3 years 18.0% vs 45.3%, log-rank 7.588, P = .006). After multivariate analysis, TII remained related to the risk of CKD5/DCGL (HR 2.344, 95% CI 1.119-4.910, P = .024) independently of other histologic and clinical variables. Conclusions In kidney transplant recipients with IgAN recurrence, TII contributes to increasing the risk of CKD5/DCGL independently of previously well-known variables. We suggest adding TII along with the Oxford classification to the clinical variables to identify recurrent IgAN patients at increased risk of graft loss who might benefit from intensified immunosuppression or specific IgAN therapies.
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Affiliation(s)
- Emilio Rodrigo
- Nephrology Department, Hospital Universitario Marqués de Valdecilla/IDIVAL, Santander, SpainRD21/0005/0010 (ISCIII RICORS2040)
| | - Luis F Quintana
- Nephrology and Renal Transplantation Department, Hospital Clinic, Barcelona, Spain
| | - Teresa Vázquez-Sánchez
- Nephrology Department, Hospital Universitario Regional de Málaga, Málaga, SpainRD21/0005/0010 (ISCIII RICORS2040)
| | - Ana Sánchez-Fructuoso
- Nephrology Department, Hospital Clínico San Carlos, Facultad de Medicina Universidad Complutense, Madrid, Spain
| | - Anna Buxeda
- Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Eva Gavela
- Nephrology Department, Hospital Universitari Dr Peset, FISABIO, Valencia, Spain
| | - Juan M Cazorla
- Nephrology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Sheila Cabello
- Nephrology Department, Hospital Universitario Son Espases, Mallorca, Spain
| | - Isabel Beneyto
- Kidney Transplant Unit, Nephrology Department, Hospital Universitario La Fe, Valencia, Spain
| | | | - Fritz Diekmann
- Nephrology and Renal Transplantation Department, Hospital Clinic, Barcelona, Spain
| | - José M Gómez-Ortega
- Pathology Department, Hospital Universitario Marqués de Valdecilla/IDIVAL, Santander, Spain
| | - Natividad Calvo Romero
- Nephrology Department, Hospital Clínico San Carlos, Facultad de Medicina Universidad Complutense, Madrid, Spain
| | | | - Asunción Sancho
- Nephrology Department, Hospital Universitari Dr Peset, FISABIO, Valencia, Spain
| | | | - Jordi Espí-Reig
- Kidney Transplant Unit, Nephrology Department, Hospital Universitario La Fe, Valencia, Spain
| | - Carlos Jiménez
- Nephrology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Domingo Hernández
- Nephrology Department, Hospital Universitario Regional de Málaga, Málaga, SpainRD21/0005/0010 (ISCIII RICORS2040)
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